Description:
The aim of this study is to compare the efficacy and safety of YIV-906 plus standard-of-care
sorafenib versus those of sorafenib alone as a first-line systemic treatment for patients
with Hepatitis B (+) associated advanced hepatocellular carcinoma.
YIV-906 (PHY906, KD018) is an immune system modulator. Clinical and preclinical research
suggests that YIV-906 could act to enhance the body's immune response to fight cancer and
increase the anti-tumor activity of sorafenib and protect and repair the gastrointestinal
tract by reducing inflammation and promoting tissue regeneration.
Inspired by a 1,800-year-old traditional medicine still in use today, YIV-906 is a botanical
drug candidate, composed of an extract of four herbs and administered in oral capsule form.
The CALM (Combination of YIV-906 and Sorafenib to treat Advanced Liver cancer in a
Multi-center study) trial is a multi-regional, randomized, placebo-controlled study.
Title
- Brief Title: YIV-906 (Formerly PHY906/KD018) With Sorafenib in HBV(+) Hepatocellular Carcinoma (HCC)
- Official Title: A Phase II Randomized Placebo-Controlled Study Investigating The Combination Of YIV-906 And Sorafenib (Nexavar®) In HBV (+) Patients With Advanced Hepatocellular Carcinoma
Clinical Trial IDs
- ORG STUDY ID:
YIV-906-2018L1
- NCT ID:
NCT04000737
Conditions
- Advanced Hepatocellular Carcinoma
Interventions
Drug | Synonyms | Arms |
---|
YIV-906+Sorafenib | | Sorafenib + YIV-906 |
Placebo+Sorafenib | | Sorafenib + Placebo |
Purpose
The aim of this study is to compare the efficacy and safety of YIV-906 plus standard-of-care
sorafenib versus those of sorafenib alone as a first-line systemic treatment for patients
with Hepatitis B (+) associated advanced hepatocellular carcinoma.
YIV-906 (PHY906, KD018) is an immune system modulator. Clinical and preclinical research
suggests that YIV-906 could act to enhance the body's immune response to fight cancer and
increase the anti-tumor activity of sorafenib and protect and repair the gastrointestinal
tract by reducing inflammation and promoting tissue regeneration.
Inspired by a 1,800-year-old traditional medicine still in use today, YIV-906 is a botanical
drug candidate, composed of an extract of four herbs and administered in oral capsule form.
The CALM (Combination of YIV-906 and Sorafenib to treat Advanced Liver cancer in a
Multi-center study) trial is a multi-regional, randomized, placebo-controlled study.
Detailed Description
HCC patients with chronic HBV (+) (HBsAg(+) and IgM anti-HBc (-)), and Child-Pugh A status
will be randomized to either the study arm (YIV-906 plus sorafenib) or control arm (placebo
plus sorafenib) at ratio of 2:1. Patients will be stratified according to metastatic status
(extrahepatic/vascular invasion vs. none), and their ECOG performance status (0 vs. 1) at
randomization.
- ARM I: Patients receive Placebo + Sorafenib
- ARM II: Patients receive YIV-906+ Sorafenib
Patients in the study arm will be treated orally each 28-day course with YIV-906 (600 mg (3
capsules) BID) + sorafenib (400 mg BID) according to the following schedule: sorafenib BID
daily treatment for 28 days, and YIV-906 BID 4 days on and 3 days off weekly in each course.
All patients will be evaluated and graded for adverse events according to the NCI Common
Terminology for Adverse Events, version 5.0 (CTCAE). The Response Evaluation Criteria in
Solid Tumors 1.1 (RECIST 1.1) will be used to establish disease response or progression.
Patients will be evaluated for PFS, TTP, OS, antitumor response every two cycles, and QoL and
safety at the beginning of each cycle. Biomarkers are mandatory and will be studied prior to
drug administration on day 1 of each cycle. Gut and oral microbiota studies as well as TCM
Syndrome Research are optional.
PK is only optional in China study sites, and limited to the first 15 male and 15 female
patients. Patients will be randomized to either study drug arm or placebo arm (2:1 ratio). PK
studied immediately prior to dose administration and at 1 hour, 2 hours, 4 hours, and 12
hours post-dose administration on Day 1 of Cycles 1.
Trial Arms
Name | Type | Description | Interventions |
---|
Sorafenib + YIV-906 | Experimental | Patients in the study arm will be treated orally for 28-day courses with YIV-906 + sorafenib | |
Sorafenib + Placebo | Active Comparator | Patients in the placebo arm will be given sorafenib with placebo | |
Eligibility Criteria
Inclusion Criteria:
- Male or females ≥ 18 years old with the ability to take oral drugs
- Diagnosis of advanced HCC according to the American Association for the Study of Liver
Diseases (AASLD) Guidelines (Heimbach et al. 2018) or diagnosis by tissue pathology
- Life expectancy of at least 3 months
- Presence of chronic hepatitis B (HBsAg (+) and IgM anti-HBc (-))
- Never received systemic antitumor therapy
- Patients must have at least one tumor lesion that meets both of the following
criteria:
- "Measurable disease" according to RECIST 1.1 , i.e. at least one measurable
lesion.
- Advanced unresectable HCC that have liver limited disease who have failed or not
candidates to local therapies including surgery and local-regional therapies; or
patients with extrahepatic disease.
- Patients with an Eastern Cooperative Oncology Group (ECOG) performance status ≤1
- Cirrhotic status of current Child-Pugh class A. Child-Pugh status should be calculated
based on clinical findings and laboratory results during the screening period
- For patients with positive HBV-DNA and/or positive HBsAg results, they must be treated
with antivirals (per local standard of care), as prophylaxis starting at least 1-2
weeks prior to receiving study drug and willingness to continue treatment for the
length of the study.
- Patients with adequate organ reserve, such as laboratory parameters:
- Absolute Neutrophil Count (ANC) ≥ 1.5 x 10^9/L
- Platelets ≥ 60000 x 10^6/L
- Hemoglobin (Hgb) ≥ 9 g/dL
- Serum alanine amino-transferase (ALT) ≤ 5 x ULN
- Adequate renal function, based upon meeting the following laboratory criteria within 7
days before randomization:
- Serum creatinine ≤ 1.5 x ULN or calculated creatinine clearance ≥ 40mL/min (using
the Cockroft-Gault equation: (140-age) x weight (kg)/(serum creatinine x 72
[mg/dL] for males. (For females multiply by 0.85) AND
- 24-hour urine protein <1 g
- Ability to understand and willingness to sign a written informed consent and to be
able to follow the visit schedule
Exclusion Criteria:
- Patients who ever have HCV infection
- Patients who have received systemic chemo-therapies or immunotherapy or molecular
target therapies
- Patients who have received any local anti-cancer therapy within 4 weeks prior to Cycle
1 treatment
- Active bleeding (including gastrointestinal bleeding, encephalopathy, and ascites)
during the last 4 weeks prior to Cycle 1 treatment
- Patients with a history of allergy to the known components of YIV-906
- Known history of human immunodeficiency virus (HIV) seropositivity
- Known central nervous system metastasis including brain metastasis and meningeal
carcinomatosis
- Hepatocholangiocarcinoma, fibrolamellar cell carcinoma and mixed hepatocellular
carcinoma
- Active malignancy (except for definitively treated melanoma in-situ, basal or squamous
cell carcinoma of the skin, or carcinoma in-situ of the cervix) within the past 5
years
- Any severe and/or uncontrolled medical conditions including but not limiting to:
- Unstable angina pectoris, symptomatic congestive heart failure, myocardial
infarction ≤ 6 months prior to Cycle 1 treatment, serious uncontrolled cardiac
arrhythmia, uncontrolled hypertension
- Previous transient ischemic attack (TIA), cerebral vascular accident (CVA),
symptomatic peripheral vascular disease (PVD) within last 6 months of Cycle 1
treatment
- Congenital long QT syndrome
- Alcoholic patients
- Acute and chronic, active infectious disorders and nonmalignant medical illnesses
that are uncontrolled or whose control may be jeopardized by this study therapy,
in the opinion of the investigator, except chronic HBV
- Impairment of gastrointestinal function or who have a gastrointestinal disease
that may significantly alter the absorption of study drugs (e.g., ulcerative
disease, uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome)
- Patients who have had organ transplantation
- Patients receiving chronic treatment with corticosteroids (except for intermittent
topical or local injection or aldosterone) or other immunosuppressive agent Subjects
receive any blood transfusion, albumin transfusion, erythropoietin (EPO), granulocyte
colony-stimulating factor (G-CSF), TPO or other medical supportive treatment prior to
Cycle 1 treatment
- Patients treated with drugs known to be strong inducers of isoenzyme CYP3A within 7
days of Cycle 1 treatment
- Patients who have undergone major surgery ≤ 2 weeks prior to starting study drug or
who have not recovered from surgery
- Patients who have received an investigational drug or therapy within the last 4 weeks
prior to Cycle 1 treatment.
- Pregnant and/or breastfeeding women
- Men and women of childbearing age and potential, who are not willing to use effective
contraception
- Unwilling or unable to follow protocol requirements or to give informed consent
- An ongoing or recent history of autoimmune, uncontrolled psychiatric disorders and
drug abuse
- Uncontrolled hereditary or acquired thrombotic or bleeding disorder
- Bowel obstruction, history or presence of inflammatory enteropathy or extensive
intestinal resection
- Therapeutic dose anticoagulation with warfarin or similar agents
- Chronic therapy with nonsteroidal anti-inflammatory agents or other antiplatelet
agents. Aspirin at doses up to 100 milligrams/day is permitted
- Patients with an estimated or calculated baseline creatinine clearance of less than 40
mL/min should not be enrolled in this trial
- No patient, however, may enroll in this trial if they are taking phenytoin (Dilantin)
- Patients taking traditional Chinese medicines within 14 days prior to taking first
dose of study treatment
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Progression free survival (PFS) |
Time Frame: | At baseline, then at the end of every two cycle (i.e. approximately every 8 weeks), until disease progression or discontinuation from study. Assessed up to 24 months. |
Safety Issue: | |
Description: | PFS is defined as the period elapsing between the date of date of randomization and the date of either disease progression or date of death, whichever is earlier. |
Secondary Outcome Measures
Measure: | Time to progression (TTP) |
Time Frame: | At baseline, then at the end of every two cycle (i.e. approximately every 8 weeks), until disease progression or discontinuation from study. Assessed up to 24 months. |
Safety Issue: | |
Description: | TTP is defined as the period elapsing between the date of randomization and the date of disease progression. |
Measure: | Overall survival (OS) |
Time Frame: | at randomization, then at the end of every two cycle (i.e. approximately every 8 weeks), until death from any cause. Assessed up to 24 months. |
Safety Issue: | |
Description: | OS is defined as the interval between time of randomization and the date of death from any cause. |
Measure: | Objective response rate (ORR) in each arm |
Time Frame: | At baseline, then at the end of every two cycle (i.e. approximately every 8 weeks), until disease progression or discontinuation from study. Assessed up to 24 months. |
Safety Issue: | |
Description: | The Response Evaluation Criteria in Solid Tumors 1.1 (RECIST 1.1) will be used to establish disease response or progression |
Measure: | Disease control rate (DCR) in each arm |
Time Frame: | At baseline, then at the end of every two cycle (i.e. approximately every 8 weeks), until disease progression or discontinuation from study. Assessed up to 24 months. |
Safety Issue: | |
Description: | DCR will be defined as the proportion of patients achieving either partial response (PR) or complete response (CR) or stable disease (SD). |
Measure: | The safety and tolerability of the combination of YIV-906 plus sorafenib as measured by the rate and severity of AEs |
Time Frame: | Continuously throughout the study until 28 days after treatment discontinuation |
Safety Issue: | |
Description: | All patients will be evaluated and graded for adverse events according to the NCI Common Terminology for Adverse Events, version 5.0 (CTCAE). |
Measure: | Change of quality of life (QoL) in each arm with HCC18 |
Time Frame: | At the beginning of every course (4 weeks) until the end of study. Assessed up to 24 months. |
Safety Issue: | |
Description: | Each of the domains in the HCC18 will be scored per the assessment's scoring algorithm and summarized using descriptive statistics at baseline |
Measure: | Change of quality of life (QoL) in each arm with EORTC-C30 |
Time Frame: | At the beginning of every course (4 weeks) until the end of study. Assessed up to 24 months. |
Safety Issue: | |
Description: | Each of the domains in the EORTC QLQ-C30 will be scored per the assessment' scoring algorithm and summarized using descriptive statistics at baseline |
Measure: | Effects of YIV-906 on mean Cmax (mg/mL) of sorafenib in blood |
Time Frame: | On Day 1 of Cycle 1 (4 week/28 days), PK studied immediately prior to dose administration and at 1 hour, 2 hours, 4 hours, and 12 hours post-dose administration. |
Safety Issue: | |
Description: | PK is optional and limited to the first 15 male and 15 female patients from China study sites. Patients will be randomized to either study drug arm or placebo arm (2:1 ratio). |
Measure: | Effects of YIV-906 on mean Tmax (Hr) of sorafenib in blood |
Time Frame: | On Day 1 of Cycle 1(4 week/28 days), PK studied immediately prior to dose administration and at 1 hour, 2 hours, 4 hours, and 12 hours post-dose administration. |
Safety Issue: | |
Description: | PK is optional and limited to the first 15 male and 15 female patients from China study sites. Patients will be randomized to either study drug arm or placebo arm (2:1 ratio). |
Measure: | Effects of YIV-906 on mean AUC0-24(mg*h/L) of sorafenib in blood |
Time Frame: | On Day 1 of Cycle 1(4 week/28 days), PK studied immediately prior to dose administration and at 1 hour, 2 hours, 4 hours, and 12 hours post-dose administration. |
Safety Issue: | |
Description: | PK is optional and limited to the first 15 male and 15 female patients from China study sites. Patients will be randomized to either study drug arm or placebo arm (2:1 ratio). |
Measure: | Effects of YIV-906 on mean AUC from time 0 to the end of the dosing period AUC0-tau (mg*h/L) of sorafenib in blood |
Time Frame: | On Day 1 of Cycle 1(4 week/28 days), PK studied immediately prior to dose administration and at 1 hour, 2 hours, 4 hours, and 12 hours post-dose administration. |
Safety Issue: | |
Description: | PK is optional and limited to the first 15 male and 15 female patients from China study sites. Patients will be randomized to either study drug arm or placebo arm (2:1 ratio). |
Measure: | Effects of YIV-906 on mean t½ (Hr) of sorafenib in blood |
Time Frame: | On Day 1 of Cycle 1(4 week/28 days), PK studied immediately prior to dose administration and at 1 hour, 2 hours, 4 hours, and 12 hours post-dose administration. |
Safety Issue: | |
Description: | PK is optional and limited to the first 15 male and 15 female patients from China study sites. |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | Yiviva Inc. |
Trial Keywords
- Adult Primary Hepatocellular Carcinoma
- Advanced Adult Primary Liver Cancer
- Advanced Adult Hepatocellular Carcinoma
- BCLC Stage B Adult Hepatocellular Carcinoma
- BCLC Stage C Adult Hepatocellular Carcinoma
- Hepatitis B (+) Associated Advanced Hepatocellular Carcinoma
- Child-Plough A Hepatocellular Carcinoma
Last Updated
December 17, 2020